Mediterranean diet ‘as effective as statins’ in reducing heart attack risk

PEOPLE at risk of a stroke or heart attack should reduce that risk by adopting the Mediterranean diet rather than necessarily taking statins, leading doctors are urging.

Eating more healthily, being more physically active and stopping smoking can be just as effective as starting to take the cholesterol-lowering drugs, they have said in a paper published on Monday.

Bodies such as the National Institute for Health and Clinical Excellence (Nice), which advise doctors how to treat patients, should rely less on medication to cut cardiovascular risk.

The call, in an editorial in the healthcare journal Prescriber, has come from a trio of doctors, including the British cardiologist, Dr. Aseem Malhotra, a prominent sceptic about the value of statins. They believe doctors should tell patients in detail about the risks and benefits of using statins or the alternative of making non-medical, lifestyle changes, and let them decide which approach they favour.

An estimated seven million people in the UK are thought to be on statins and their numbers are set to rise because Nice last year lowered their criteria for those it deems may benefit from the drugs. Anyone with a 10 per cent chance of having a stroke or heart attack in the next 10 years is meant to be offered one, where previously the threshold was a 20 per cent risk.

But the two main bodies representing General Practitioners (GPs), the British Medical Association and the Royal College of GPs, have voiced serious concern about the NHS advisory body’s updated guidance, even though family doctors are offered cash payments for implementing it. They have warned that the credibility of the quality outcomes framework for paying doctors is at risk because of the new 10 per cent rule and are concerned that the change risks over-medicating some of the population.

The authors’ call has drawn support from some doctors’ leaders. “For most middle-aged people wishing to avoid heart disease, a healthy diet offers a far more powerful, sustainable and enjoyable plan than lifelong statin tablets,” said Prof Simon Capewell, vice-president of the United Kingdom (UK) Faculty of Public Health.

In the paper they point out that about 80 per cent of cardiovascular disease – which is Britain’s biggest killer, claiming one in three lives – is caused by “modifiable lifestyle factors such as nutrition, physical activity and smoking.”

When doctors are discussing with those in danger of a stroke or heart attack how to reduce their risk, the paper says: “Patients should be counselled about the nature and value of a healthy diet. A Mediterranean diet in moderation, with as little processed food as possible, is a cardiovascular intervention tested in randomised trials and shown to reduce CVD events.”

In addition, “patients should know that physical activities, particularly enjoyable ones, can lead to important, lasting health and quality of life benefits”, and they should also be advised to stop smoking.